If Ebola hits Lagos, we're in big trouble

Liberians look on at the body of a victim of Ebola on a street corner in the capital Monrovia on Saturday. The spread of the virus inside Nigeria

The World Health Organisation has declared the epidemic a global health emergency, but this is just the beginning

Attention World: You just don't get it.

You think there are magic bullets in some rich country's freezers that will instantly stop the relentless spread of the Ebola virus in West Africa? You think airport security guards in Los Angeles can look a traveller in the eyes and see infection, blocking that jet passenger's entry into La-la land? You believe novelist Dan Brown's utterly absurd description of a World Health Organisation that has a private C5-A military transport jet and disease SWAT team that can swoop into outbreaks, saving the world from contagion?

Wake up, fools. What's going on in West Africa now isn't Brown's silly Inferno scenario - it's Steven Soderberg's movie "Contagion", though without a modicum of its high-tech capacity.

Last week, former US ambassador to Nigeria John Campbell warned that spread of the virus inside Lagos - which has a population of 22 million - would instantly transform this situation into a worldwide crisis, thanks to the chaos, size, density and mobility of not only that city but dozens of others in the enormous, oil-rich nation. Add to the Nigerian scenario civil war, national elections, Boko Haram terrorists, and a country-wide doctors' strike - all of which are real and current - and you have a scenario so overwrought and frightening that I could not have concocted it even when I advised screenwriter Scott Burns on his "Contagion" script.

Globally, politicians and much of the media are focused on wildly experimental drugs and vaccines, and equally wild notions of "keeping the virus out" by barring travellers and "screening at airports".

Let's be clear: Absolutely no drug or vaccine has been proven effective against the Ebola virus in human beings. To date, only one person - Kent Brantly - has apparently recovered after receiving one of the three prominent putative drugs, and there is no proof that the drug was key to his improvement. None of the potential vaccines has even undergone Phase One safety trials in humans.

We are in for a very long haul with this extremely deadly disease - it has killed more than 50 per cent of those confirmed infected, and possibly more than 70 per cent of the infected populations of Liberia, Sierra Leone and Guinea. Nigeria is struggling to ensure that no secondary spread of Ebola comes from one of the people already infected by Liberian traveller Patrick Sawyer - two of whom have died so far.

Since the Ebola outbreak began in March there have been many reports of isolated cases of the disease in travellers to other countries. None have resulted, so far, in secondary spread, establishing new epidemic focuses of the disease. As I write this, such a case is thought to have occurred Johannesburg, South Africa's largest city, and another suspected case died in isolation in Jeddah, Saudi Arabia, prompting the kingdom to issue special Ebola warnings for the upcoming hajj. It's only a matter of time before one of these isolated cases spreads, possibly in a chaotic urban centre far larger than the ones in which it is now claiming lives: Conakry, Guinea; Monrovia, Liberia; and Freetown, Sierra Leone.

So what does "getting it" mean for understanding what we, as a global community, must now do?

First of all, we must appreciate the scale of need on the ground in the three Ebola-plagued nations. While the people may pray for magic bullets, their health providers are not working in Hollywood, but rather in some of the most impoverished places on Earth. Before Ebola, these countries spent less than $100 (Bt3,200) per year per capita on healthcare. Most Americans spend more than that annually on aspirin and ibuprofen.

On August 8, the World Health Organisation (WHO) declared the Ebola epidemic a "public health emergency of international concern".

"It's like fighting a forest fire: leave behind one burning ember, one case undetected, and the epidemic could re-ignite," US Centres for Disease Control and Prevention director Dr Tom Frieden recently told Congress. "Ending this outbreak will take time, at least three to six months in a best case scenario, but this is very far from a best case scenario."

Ken Isaacs of Samaritan's Purse, the aid organisation that had two of its members fighting for their lives in Ebola quarantine in Atlanta, told Congress, "It took two Americans getting the disease in order for the international community and United States to take serious notice of the largest outbreak of the disease in history. That the world would allow two relief agencies to shoulder this burden along with the overwhelmed Ministries of Health in these countries, testifies to the lack of serious attention the epidemic was given."

Despite current response mechanisms, this Ebola outbreak, Isaacs said as he closed his remarks, "is uncontained and out of control in West Africa".

Even if the world dodges a viral bullet and Ebola fails to take hold in a metropolis in a different country (such as Lagos, Johannesburg, Delhi or Sao Paulo), controlling the disease and saving lives in Liberia, Sierra Leone and Guinea will require resources on a scale nobody has delineated. The emotionally distraught doctors and nurses on the front lines are screaming for help.

The lion's share of care to date has been provided by one group, Doctors Without Borders, which is pleading for others to relieve their exhausted ranks - 600 people who have been fighting for months on the front lines in this war.

Nothing could be clearer than this Doctors Without Borders press release, dated August 8:

"For weeks, MSF has been repeating that a massive medical, epidemiological and public health response is desperately needed to saves lives and reverse the course of the epidemic. Lives are being lost because the response is too slow."

The list of supplies Emmet A Dennis, president of the University of Liberia, e-mailed that he needs for his medical school personnel now fighting cases in Monrovia includes medical gowns, latex gloves, body bags, face masks, disinfectant soap and rehydration fluids.

It simply does not get more basic. As there are no miracle drugs for Ebola, the needs include few medicines.

And of course this list assumes Ebola remains confined in terms of secondary spread to Liberia, Sierra Leone, and Guinea. If the virus takes hold in another, more populous nation, the needs will grow exponentially, and swiftly.

Laurie Garrett is senior fellow for global health at the Council on Foreign Relations and a Pulitzer Prize-winning science writer.